Candidiasis Disease

BASICS

DESCRIPTION

Candida albicans and related species cause a variety of infections. Cutaneous candidiasis syndromes include erosio interdigitalis blastomycetica, folliculitis, balanitis, intertrigo, paronychia, onychomycosis, diaper rash, perianal candidiasis, and the syndromes of chronic mucocutaneous candidiasis. Mucous membrane infections include oral candidiasis (thrush), esophagitis, and vaginitis. The most serious manifestation of candidiasis is hematogenously disseminated candidiasis (sometimes referred to as acute systemic candidiasis).

System(s) affected: Skin/Exocrine, Gastrointestinal, Reproductive, Pulmonary, Renal/Urologic
Genetics: N/A
Incidence/Prevalence in USA: Approximately 50/100,000. Hematogenously disseminated candidiasis affects at least 120,000 patients annually in the USA.
Predominant age: All ages are susceptible to hematogenously disseminated candidiasis. Premature neonates are at particularly high risk.
Predominant sex: Male = Female (hematogenously disseminated candidiasis)

SIGNS AND SYMPTOMS

Fever
Malaise
Tachycardia
Hypotension
Altered mental status
Hepatosplenomegaly
Maculopapular or nodular skin rash

CAUSES

Most Candida infections are due to Candida albicans. However, other important human pathogens include C. tropicalis, C. krusei, C. stellatoidea, C. pseudotropicalis, C. guilliermondi, C. parapsilosis, C. lusitaniae, C. lambica, and C. glabrata.
Candida species colonize human mucocutaneous surfaces, and most infections are endogenously acquired from this reservoir
Human-to-human transmission of Candida occurs in some settings

RISK FACTORS

For hematogenously disseminated candidiasis:
- Neutropenia
- Antibacterial chemotherapy
- Indwelling intravascular access devices
- Prior hemodialysis
- Mucocutaneous candidiasis
- Cardiothoracic or abdominal surgery

DIAGNOSIS

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

The characteristic histopathology of lesions of Candida invasion of visceral organs is microabscess formation

SPECIAL TESTS

The diagnosis is established by isolating the causative organism from blood cultures (lysis/centrifugation blood cultures are superior to broth culture techniques for this purpose) or other normally sterile body sites, or by demonstration of organisms in histopathologic specimens of normally sterile tissues
Isolation of Candida from multiple sites should raise the diagnostic suspicion of hematogenously disseminated candidiasis

IMAGING

Imaging techniques are generally not specifically useful in the diagnosis of hematogenously disseminated candidiasis. However, in the syndrome of hepatosplenic candidiasis (chronic systemic candidiasis) imaging of the liver and spleen by liver scan, ultrasound, or CT (the most sensitive) may be useful in suggesting this syndrome as the cause of persistent fever and liver dysfunction in patients who have recently recovered from neutropenia.

DIAGNOSTIC PROCEDURES

If blood cultures remain consistently negative, excisional biopsy may be useful in diagnosis. Aspiration and biopsy of skin lesions occasionally seen with hematogenously disseminated candidiasis is also useful.

TREATMENT

APPROPRIATE HEALTH CARE

Inpatient for hematogenously disseminated candidiasis

GENERAL MEASURES

Fluid and electrolyte therapy is often required
Hemodynamic and respiratory support may be required in seriously ill patients
Removal of potentially infected intravascular access devices is imperative

SURGICAL MEASURES

N/A

ACTIVITY

As tolerated

DIET

No special diet

PATIENT EDUCATION

Patients should be advised of the nature of the infection and the toxicities associated with therapy

FOLLOW UP

PREVENTION/AVOIDANCE

Fluconazole 400 mg/day reduces the incidence of candidiasis in patients undergoing induction therapy for acute leukemia or bone marrow transplantation

POSSIBLE COMPLICATIONS

Of hematogenously disseminated candidiasis
- Pyelonephritis
- Endophthalmitis
- Endocarditis, myocarditis, pericarditis
- Arthritis, chondritis, osteomyelitis
- Pneumonitis
- Central nervous system infection

EXPECTED COURSE AND PROGNOSIS

Overall mortality for patients with hematogenously disseminated candidiasis is 40-75%, with mortality attributable to candidemia being 15-37%

MISCELLANEOUS

ASSOCIATED CONDITIONS

See Risk Factors

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

Other candidal infections: Intraperitoneal infection in patients with major abdominal surgery, biliary tract candidiasis, isolated lower urinary tract infection

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.